Nutritional support after hepatic resection: A randomized prospective study

Background: A consensus as to whether hypertonic dextrose should be given to patients with chronic liver diseases such as cirrhosis or chronic hepatitis after major hepatectomy has not been reached, mostly because metabolism in the remnant liver switches from utilization of blood glucose to utilization predominantly of fatty acid as an energy source. We investigated whether nutritional support would have beneficial effects for such patients. Patients and Methods: Among 19 patients, 10 were given peripheral dextrose (10 kcal/kg/day) for seven days following hepatectomy and the other 9 were given hypertonic glucose. Twenty and 30 kcal/kg/day was the average non-protein caloric intake, including free oral intake during the first one week following hepatectomy, respectively. Results: The groups were comparable with regard to laboratory data and operative stress. There were no untoward effects related to this support. In patients given nutritional support, retinol binding protein and prealbumin improved (p<0.05 and p<0.05, respectively), urinary 3-methylhistidine excretion decreased (p<0.01) and the nitrogen balance normalized earlier (p<0.05), as compared to findings with the conventional method. Conclusion: The remnant liver can utilize dextrose and nutritional support improves the nutritional status and may even preserve muscle protein mass.